Patients Undergoing Interventions for Claudication Experience Low Perioperative Morbidity but Are at Risk for Worsening Functional Status and Limb Los
Scott Levin1, Alik Farber1, Thomas Cheng1, Nkiruka Arinze1, Douglas Jones1, Denis Rybin2, Jeffrey Siracuse1 1Boston Medical Center, Boston University School of Medicine, Boston, MA, USA 2Boston University School of Public Health, Boston, MA, USA
Background:
Interventional approaches to managing claudication vary widely. According to Society for Vascular Surgery guidelines, any invasive treatment for claudication must offer long-term benefit with a low risk of complications. Our aim was to evaluate contemporary claudication intervention patterns and outcomes.
Methods:
The VSGNE database (2003-2018) was queried for peripheral vascular interventions (PVI), infrainguinal bypasses, and suprainguinal bypasses for claudication. Perioperative and one-year outcomes were evaluated.
Results:
7051 PVI, 2527 infrainguinal bypasses, and 849 suprainguinal bypasses treated claudication. Preoperative rates of statin use and current smoking were 76-80% and 40-60%, respectively. PVI treatment levels were iliac (52%), femoral-popliteal (54%), and tibial (6%). Isolated tibial interventions were performed in 2%. Infrainguinal bypasses were most often to the popliteal artery, however in 19% of cases, bypasses were to tibial targets. Suprainguinal bypasses originated primarily from the abdominal aorta (89%), but also from the axillary artery (11%). Overall, thirty-day mortality was .4-2%. After one year, of patients initially ambulating without assistance, 2.4-3.6% required assistance and .3-1.3% were non-ambulatory. Ipsilateral reintervention/amputation-free survival, ipsilateral major amputation-free survival, and survival at one year were 81.4-90.6%, 92.9-94.1%, and 95.3-97%, respectively.
Conclusion:
Claudication interventions had low perioperative morbidity, yet patients were at risk for worse functional status and limb loss at one year. A subset of patients received non-traditional treatments, including isolated tibial PVI and bypasses with axillary inflow or tibial outflow. Not all patients were on guideline-directed medical therapy. The data emphasize the importance of careful patient selection, medical optimization, and setting realistic expectations during informed consent.
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